Intravenous iron replacement
LMW iron dextran — LMW ID (INFeD, CosmoFer) is the least expensive of the IV iron formulations that can be administered in a single, large dose (total dose infusion).
LMW ID can be given as multiple doses of 2 mL (equivalent to 100 mg elemental iron, based on a concentration of 50 mg elemental iron per mL). LMW ID can also be given as a single, total dose infusion. We often give a total dose infusion of 1000 mg in 250 mL of normal saline over one hour. Although this is not a US Food and Drug Administration-approved dosing, doctors have not observed any serious adverse events with this approach in 1000’s of administrations.
A test dose is required prior to the first dose of LMW ID (0.5 mL [25 mg]). This may be given gradually over at least 30 seconds; we prefer to administer the test dose over five minutes while observing the patient. If no symptoms occur during the first 5 to 10 minutes, it is extremely unlikely that an infusion reaction will occur. After the test dose, we administer the remainder of a 1000 mg dose over the balance of one hour.